Audit Coordinator at Mass General Brigham(PHS)

Posted in Other 12 days ago.

Location: Somerville, Massachusetts





Job Description:

About Us


As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Founded by Brigham and Women's Hospital and Massachusetts General Hospital, MGB supports a complete continuum of care including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care and other health-related entities. Several of our hospitals are teaching affiliates of Harvard Medical School, and our system is a national leader in biomedical research.


We're focused on a people-first culture for our system's patients and our professional family. That's why we provide our employees with more ways to achieve their potential. Mass General Brigham is committed to aligning our employees' personal aspirations with projects that match their capabilities and creating a culture that empowers our managers to become trusted mentors. We support each member of our team to own their personal development-and we recognize success at every step.


Our employees use the Mass General Brigham values to govern decisions, actions and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration.



General Overview



Reporting to the Audit Manager, the Charge Audit Coordinator position is responsible for the coordination and facilitation of all activities pertinent to Charge Audits being conducted at Brigham & Women's Hospital, Brigham & Women's Faulkner Hospital, Massachusetts General Hospital, Newton Wellesley Hospital, and North Shore Medical Center (other entities as assigned) in accordance with the PHS Charge Audit Policy and established departmental policies and procedures.



Principal Duties and Responsibilities





  • Coordinates the scheduling of audits with external Payer Audit Representatives/Payers to initiate the charge audit process.

  • Oversees the preparation of detailed packages for cases selected by Payer Audit Representatives, including itemized bills and other necessary documents needed to initiate the audit process

  • Ensures timely requests are made to Health Information Management (HIM) for preparation of third party/charge audits, including patient authorizations, as defined by the PHS Charge Audit Policies

  • Communicates with Payer Audit Representatives throughout the audit process and performs follow-up as needed

  • Documents and summarizes findings in a clear, concise, and effective manner to preserve PHS appeal rights and to assist with improvements in the charge capture process

  • Conducts post audit research to support and defend cited charges by obtaining additional documentation and works directly (via, phone, fax, or secure email) with the Payer Audit Representative to arrive at agreed upon audit outcomes in a timely manner.

  • Documents the findings and final outcomes of all accounts reviewed by the Payer Audit Representative in the PHS Audit Tracking tool and respective billing system

  • Communicates areas of identified opportunities for revenue improvement to Revenue Integrity Management team. Opportunities can include results from under billed and/or unbilled services/items based on supporting documentation in the medical record when compared to itemized billed charges, or list of active charge codes for a given cost center.

  • Identifies ongoing issues with charging, coding, billing system edits and documentation for discussion with Revenue Integrity Staff and recommends corrective actions to prevent future losses.

  • Maintains internal systems used for tracking and reporting of findings, including but not limited to, PHS Audit Tracking System, patient accounting systems, spreadsheets, databases, to facilitate monthly management reporting

  • Develops and maintains professional working relationships with internal and external stakeholders to facilitate continuous process improvement as it relates to audit activity and findings






Qualifications

Qualifications



  • Minimum of 2 years of billing audit experience

  • Format and content of a medical record and various forms of medical/clinical documentation

  • Medical Terminology and coding including CPT and HCPCs

  • State and Federal Regulations concerning the use, disclosure and confidentiality of patient records

  • Auditing principles and standards as applicable to charge audits

  • Billing, claim forms and charge capture procedures


Skills/Abilities/Competencies



  • Excellent oral and written communication skills.

  • Effective negotiating skills including the ability to resolve cited charge issues by extracting supportive documentation for dispute resolution/appeals purposes are required.

  • Team and service oriented.

  • Ability to interact with all levels of health care personnel and hospital/finance management and build strong working relationships with internal and external customers.

  • Strong organizational and time management skills.

  • Ability to work independently in a role that requires flexibility in an environment that is deadline driven.

  • Ability to identify root cause of issues uncovered in the charge audit process and gather, organize and present issues to appropriate areas with recommendations for corrective actions.

  • Experience with computer software programs such as Word and Excel are required.

  • Ability to function as a department subject matter expert and resource with a focus on contributing to the achievement of departmental and corporate goals.






EEO Statement

Mass General Brigham is an Equal Opportunity Employer & by embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law.
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